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HomeMy WebLinkAboutNC0075027_Renewal (Application)_20220620rPrint All Pages North Carolina Department of Environmental Quality Division of Water Resources IPrint Form Only Modified Application Form 2A Revised March 2021 Modified Application Form 2A Minor Sewage Facilities < 0.1 MGD and No Pretreatment Program NPDES Permitting Program Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works. NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Form NPDES NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow the instructions may result in denial of the application.) Facility Information N I IC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9)) Facility name Cainsway Mailing address (street or P.O. box) P.O. Box 846 City or town Walkertown State NC ZIP code 27051 Contact name (first and last) Daryl Cain Title HOA President Phone number (336) 391-0737 Email address Cdcstcktrdr@aol.com Location address (street, route number, or other specific identifier) Pinehall Road ❑ Same as mailing address City or town North of Walkertown State NC ZIP code 27051 Is this application for a facility that has yet to commence discharge? ❑ Yes 4 See instructions on data submission requirements for new dischargers. ✓ No Applicant Information 1.3 Is applicant different from entity listed under Item 1.1 above? ❑ Yes ✓ No 4 SKIP to Item 1.4. Applicant name Applicant address (street or P.O. box) City or town State ZIP code Contact name (first and last) Title Phone number Email address 1.4 Is the ✓ applicant the facility's owner, operator, or both? (Check only one response.) Owner ❑ Operator ❑ Both 1.5 To which entity should the NPDES permitting authority send correspondence? (Check ❑ Facility ❑ Applicant ..1Facility only one response.) and applicant (they are one and the same) Existing Environmental Permits 1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit number for each.) Existing Environmental Permits ✓ NPDES (discharges to surface water) ❑ RCRA (hazardous waste) ❑ UIC (underground injection control) ❑ PSD (air emissions) ❑ Nonattainment program (CAA) ❑ NESHAPs (CAA) ❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify) Page 1 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Collection System and Population Served 1.7 Provide the collection system information requested below for the treatment works. Municipality Served Population Served Collection System Type (indicate percentage) Ownership Status 100 % separate sanitary sewer 0 Own 0 Maintain 125 % combined storm and sanitary sewer 0 Own 0 Maintain ❑ Unknown 0 Own 0 Maintain % separate sanitary sewer 0 Own ❑ Maintain % combined storm and sanitary sewer ❑ Own ❑ Maintain ❑ Unknown 0 Own ❑ Maintain % separate sanitary sewer 0 Own ❑ Maintain % combined storm and sanitary sewer 0 Own 0 Maintain ❑ Unknown 0 Own 0 Maintain % separate sanitary sewer 0 Own 0 Maintain % combined storm and sanitary sewer 0 Own ❑ Maintain Total Population Served 125 ❑ Unknown Separate Sanitary Sewer System ❑ Own ❑ Maintain Combined Storm and Sanitary Sewer Total percentage of each type of sewer line (in miles) 100 % 0 /o Indian Country 1.8 Is the treatment works located in Indian ❑ Yes Country? I No 1.9 Does the facility discharge to a receiving ❑ Yes water that flows through ✓ Indian Country? No Design and Actual Flow Rates 1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate .0432 mgd Annual Average Flow Rates (Actual) Two Years Ago Last Year This Year mgd mgd mgd Maximum Daily Flow Rates (Actual) Two Years Ago Last Year This Year mgd mgd mgd Discharge Points by Type 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type. Total Number of Effluent Discharge Points by Type Treated Effluent Untreated Effluent Combined Sewer Overflows Bypasses Constructed Emergency Overflows 1 Page 2 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Outfalls and Other Discharge or Disposal Methods Outfalls Other Than to Waters of the State of North Carolina 1.12 Does the POTW discharge wastewater to basins, ponds, for discharge to waters of the State of North Carolina? ❑ Yes or other surface impoundments that do not have outlets 4 SKIP to Item 1.14. ✓ No 1.13 Provide the location of each surface impoundment and associated discharge information in the table below. Surface Impoundment Location and Discharge Data Location Average Daily Volume Discharged to Surface Impoundment Continuous or Intermittent (check one) gpd ❑ Continuous ❑ Intermittent gpd ❑ Continuous 0 Intermittent gpd ❑ Continuous 0 Intermittent 1.14 Is wastewater applied to land? ❑ Yes 4 SKIP to Item 1.16. I No 1.15 Provide the land application site and discharge data requested below. Land Application Site and Discharge Data Location Size Average Daily Volume Applied Continuous or Intermittent (check one) acresgpd ❑ Continuous ❑ Intermittent acresgpd ❑ Continuous ❑ Intermittent acresgpd ❑ Continuous ❑ Intermittent 1.16 Is effluent transported to another facility for ❑ Yes treatment prior to discharge? 4 SKIP to Item 1.21. ✓ No 1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe). 1.18 Is the effluent transported by a party other than the applicant? ❑ Yes ❑ No 4 SKIP to Item 1.20. 1.19 Provide information on the transporter below. Transporter Data Entity name Mailing address (street or P.O. box) City or town State ZIP code Contact name (first and last) Title Phone number Email address Page 3 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Outfalls and Other Discharge or Disposal Methods Continued 1.20 In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the receiving facility. Receiving Facility Data Facility name Mailing address (street or P.O. box) City or town State ZIP code Contact name (first and last) Title Phone number Email address NPDES number of receiving facility (if any) 0 None Average daily flow rate mgd 1.21 Is the wastewater disposed of in a manner other than not have outlets to waters of the State of North Carolina ❑ Yes ✓ those a ready mentioned in Items 1.14 through 1.21 that do (e.g., underground percolation, underground injection)? No 4 SKIP to Item 1.23. 1.22 Provide information in the table below on these other disposal methods. Information on Other Disposal Methods Disposal Method Description Location of Disposal Site Size of Disposal Site Annual Average Daily Discharge Volume Continuous or Intermittent (check one) acres gpd 0 Continuous 0 Intermittent acres gpd 0 Continuous 0 Intermittent acres gpd 0 Continuous 0 Intermittent Variance Requests 1.23 Do Consult ❑ ✓ you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply. with your NPDES permitting authority to determine what information needs to be submitted and when.) Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section Section 301(h)) 302(b)(2)) Not applicable Contractor Information 1.24 Are the ✓ any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works responsibility of a contractor? Yes ❑ No +SKIP to Section 2. 1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational and maintenance responsibilities. Contractor Information Contractor 1 Contractor 2 Contractor 3 Contractor name (company name) Bradley Flynt Mailing address (street or P.O. box) 8467 southard Road City, state, and ZIP code Stokesdale, NC 27357 Contact name (first and last) Bradley Flynt Phone number (336) 430-6262 Email address bradley.flynt@greensboro-nc.€ Operational and maintenance responsibilities of contractor All operations and some mantenance Page 4 SECTION c 2. ADDITIONAL INFORMATION Outfalls to Waters of NPDES Permit Number NC0075027 (40 CFR 122.21(j)(1) and the State of North Carolina Facility Name Cainsway HOA (2)) Modified Application Form 2A Modified March 2021 2.1 Does the treatment works have a design ❑ Yes flow greater than or equal to 0.1 mgd? No 4 SKIP to Section 3. ✓ Inflow and Infiltration 2.2 Provide the treatment works' current average daily volume of inflow and infiltration. Average Daily Volume of Inflow and Infiltration gpd Indicate the steps the facility is taking to minimize inflow and infiltration. Topographic Map 2.3 Have you attached a topographic map to this application that contains all the required information? (See instructions for specific requirements.) ❑ Yes ❑ No Flow Diagram 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information? (See instructions for specific requirements.) ❑ Yes ❑ No Scheduled Improvements and Schedules of Implementation 2.5 Are improvements to the facility scheduled? ❑ Yes ❑ No 4 SKIP to Section 3. Briefly list and describe the scheduled improvements. 1. 2. 3. 4. 2.6 Provide scheduled or actual dates of completion for improvements. Scheduled or Actual Dates of Completion for Improvements Scheduled Improvement (from above) Affected Outfalls (list outfall number) Begin Construction (MM/DD/YYYY) End Construction (MM/DD/YYYY) Begin Discharge (MM/DD/YYYY) Attainment of Operational Level (MM/DD/YYYY) 1. 2. 3. 4. 2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your response. ❑ Yes ❑ No ❑ None required or applicable Explanation: Page 5 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Description of Outfalls ORMATION ON EFFLUENT DISCHARGES (40 CFR 122.21(j)(3) to (5)) Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.) Outfall Number o01 Outfall Number Outfall Number State North Carolina County Forsyth City or town Walkertown Distance from shore 5 ft. ft. ft. Depth below surface o ft. ft. ft. Average daily flow rate .007 mgd mgd mgd Latitude ° Longitude ° " Seasonal or Periodic Discharge Data 3.2 Do any of the outfalls described ❑ Yes under Item 3.1 have seasonal or periodic ✓ discharges? No 4 SKIP to Item 3.4. 3.3 If so, provide the following information for each applicable outfall. Outfall Number Outfall Number Outfall Number Number of times per year discharge occurs Average duration of each discharge (specify units) Average flow of each discharge mgd mgd mgd Months in which discharge occurs Diffuser Type 3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser? ❑ Yes ✓ No 4 SKIP to Item 3.6. 3.5 Briefly describe the diffuser t pe at each applicable outfall. Outfall Number Outfall Number Outfall Number Waters of the U.S. 3.6 Does one ✓ the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from or more discharge points? Yes ❑ No 4SKIP to Section 6. Page 6 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Receiving Water Description 3.7 Provide the receiving water and related information (if known) for each outfall. Outfall Number 001 Outfall Number Outfall Number Receiving water name Ader Creek Name of watershed, river, or stream system Roanoke U.S. Soil Conservation Service 14-digit watershed code Name of state management/river basin U.S. Geological Survey 8-digit hydrologic cataloging unit code Critical low flow (acute) cfs cfs cfs Critical low flow (chronic) cfs cfs cfs Total hardness at critical low flow mg/L of CaCO3 mg/L of CaCO3 mg/L of CaCO3 Treatment Description 3.8 Provide the following information describing the treatment provided for discharges from each outfall. Outfall Number 001 Outfall Number Outfall Number Highest Level of Treatment (check all that apply per outfall) 0 Primary 0 Equivalent to secondary 0 Secondary ❑ Advanced ❑ Other (specify) 0 Primary 0 Equivalent to secondary 0 Secondary 0 Advanced 0 Other (specify) ❑ Primary ❑ Equivalent to secondary 0 Secondary 0 Advanced 0 Other (specify) Design Removal Rates by Outfall BODs or CBOD5 85 TSS 93 % % ok Phosphorus l Not applicable 0 Not applicable 0 Not applicable Nitrogen 0 Not applicable 0 Not applicable 0 Not applicable Other (specify) 0 Not applicable 0 Not applicable 0 Not applicable Page 7 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Treatment Description Continued 3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by season, describe below. Outfall Number 001 Outfall Number Outfall Number Disinfection type Hypochlorite Tablets Seasons used all Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable ✓ Yes ❑ Yes ❑ Yes ❑ No ❑ No ❑ No Effluent Testing Data 3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package? ❑ Yes ❑ No 3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's discharges or on any receiving water near the discharge points? ❑ Yes ✓ No 4 SKIP to Item 3.13. 3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's discharges by outfall number or of the receiving water near the discharge points. Outfall Number Outfall Number Outfall Number Acute Chronic Acute Chronic Acute Chronic Number of tests of discharge water Number of tests of receiving water 3.14 Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have reasonable potential to discharge chlorine in its effluent? ✓ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine. 3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application package? ❑ Yes ✓ No Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and 3.18 attached the results to this application package? ❑ Yes No sampling required by NPDES authority. ✓ additional permitting Page 8 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 Effluent Testing Data Continued 3.19 Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application or (2) at least four annual WET tests in the past 4.5 years? ❑ Yes ❑ No 4 Complete tests and Table E and SKIP to Item 3.26. 3.20 Have you previously submitted the results of the above ❑ Yes tests to your NPDES permitting No 4 Provide authority? results in Table E and SKIP to Item 3.26. 3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results. Date(s) Submitted (MM/DD/YYYY) Summary of Results 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in toxicity? ❑ Yes ❑ No 4 SKIP to Item 3.26. 3.23 Describe the cause(s) of the toxicity: 3.24 Has the treatment works conducted a toxicity reduction evaluation? ❑ Yes ❑ No 4 SKIP to Item 3.26. 3.25 Provide details of any toxicity reduction evaluations conducted. 3.26 Have you completed Table E for all applicable outfalls ❑ Yes and attached the results to the application Not package? because previously submitted NPDES permittin. authorit . applicable information to the Page 9 NPDES Permit Number NC0075027 Facility Name Cainsway HOA Modified Application Form 2A Modified March 2021 cn Checklist and Certification Statement 0 rn rncr, n 2 ECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d)) In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not all applicants are required to provide attachments. Column 1 Column 2 Section 1: Basic Application ❑ wl variance request(s) ❑ w/ additional attachments Information for All Applicants ❑ Section 2: Additional Information ❑ w/ topographic map ❑ wl process flow diagram ❑ w/ additional attachments ❑ Section 3: Information on Effluent Discharges ❑ wl Table A ❑ w/ Table D ❑ w/ Table B ❑ wl additional attachments ❑ w/ Table C Section 4: Not Applicable Section 5: Not Applicable ❑ Section 6: Checklist and Certification Statement ❑ w/ attachments Certification Statement I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name (print or type first and last name) Bradley T. Flynt Official title ORC Signature Date signed Page 10 NPDES Permit Number Facility Name Outfall Number NC0075027 Cainsway HOA 001 Modified Application Form 2A Modified March 2021 TABLE A. EFFLUENT PARAMETERS Pollutant FOR ALL POTWS Maximum Daily Discharge Average Daily Discharge Analytical Methods Methods( ML or MDL include units ) Value Units Value Units Number of Samples Biochemical oxygen demand IllBOD5 or ❑ CBOD5 (report one) 22 mg/I 3.2 mg/I 36 ❑ ML ❑MDL Fecal coliform 200/100m1 #/100m1 0 #/100 36 ❑ ML ❑ MDL Design flow rate .0432 mgd .009 mgd 36 pH (minimum) 6 su AL — Mr pH (maximum) 9 su Temperature (winter) deg. c 14.1 deg. c 21 Temperature (summer) deg. c 23.2 deg. c 15 Total suspended solids (TSS) 30 MG/I 4.8 mg/I 36 ❑ ML 0 MDL 1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). Page 11 EPA Identification Number NPDES Permit Number NC0075027 Facility Name Cainsway HOA Outfall Number Modified Application Form 2A Modified March 2021 TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD Pollutant Maximum Daily Discharge Average Daily Discharge Analytical Methods ML or MDL (include units) Value Units Value Units Number of Samples Ammonia (as N) ❑ ML ❑ MDL Chlorine (total residual, TRC)2 ❑ ML ❑ MDL Dissolved oxygen ❑ ML ❑ MDL Nitrate/nitrite ❑ ML ❑ MDL Kjeldahl nitrogen ❑ ML ❑ MDL Oil and grease ❑ ML ❑ MDL Phosphorus ❑ ML ❑ MDL Total dissolved solids ❑ ML ❑ MDL 1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). 2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not required to report data for chlorine. EPA Form 3510-2A (Revised 3-19) Page 12 TABLE EPA Identification Number C. EFFLUENT PARAMETERS NPDES Permit Number NC0075027 FOR SELECTED POTWS Maximum Daily Discharge Facility Name Cainsway HOA Average Outfall Number Daily Discharge Modified Analytical Method1 Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant Value Units Value Units Number of Samples Metals, Cyanide, and Total Phenols Hardness (as CaCO3) ❑ ML 0 MDL Antimony, total recoverable ❑ ML ❑ MDL Arsenic, total recoverable ❑ ML ❑ MDL Beryllium, total recoverable ❑ ML ❑ MDL Cadmium, total recoverable ❑ ML ❑ MDL Chromium, total recoverable ❑ ML ❑ MDL Copper, total recoverable ❑ ML ❑ MDL Lead, total recoverable ❑ ML ❑ MDL Mercury, total recoverable ❑ ML ❑ MDL Nickel, total recoverable 0 ML ❑ MDL Selenium, total recoverable 0 ML ❑ MDL Silver, total recoverable 0 ML ❑ MDL Thallium, total recoverable 0 ML ❑ MDL Zinc, total recoverable 0 ML ❑ MDL Cyanide 0 ML ❑ MDL Total phenolic compounds ❑ ML ❑ MDL Volatile Organic Compounds Acrolein ❑ ML ❑ MDL Acrylonitrile ❑ ML ❑ MDL Benzene ❑ ML ❑ MDL Bromoform 0 ML ❑ MDL EPA Form 3510-2A (Revised 3-19) Page 13 TABLE EPA Identification Number C. EFFLUENT PARAMETERS NPDES Permit Number NC0075027 FOR SELECTED POTWS Maximum Daily Discharge Facility Name Cainsway HOA Average Outfall Number Daily Discharge Modified Analytical Method1 Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant Value Units Value Units Number of Samples Carbon tetrachloride ❑ ML ❑ MDL Chlorobenzene ❑ ML ❑ MDL Chlorodibromomethane 0 ML ❑ MDL Chloroethane ❑ ML ❑ MDL 2-chloroethylvinyl ether ❑ ML ❑ MDL Chloroform ❑ ML ❑ MDL Dichlorobromomethane ❑ ML ❑ MDL 1,1-dichloroethane ❑ ML ❑ MDL 1,2-dichloroethane ❑ ML ❑ MDL trans-1,2-dichloroethylene ❑ ML ❑ MDL 1,1-dichloroethylene ❑ ML ❑ MDL 1,2-dichloropropane ❑ ML ❑ MDL 1,3-dichloropropylene ❑ ML ❑ MDL Ethylbenzene ❑ ML ❑ MDL Methyl bromide ❑ ML ❑ MDL Methyl chloride ❑ ML ❑ MDL Methylene chloride ❑ ML ❑ MDL 1,1,2,2-tetrachloroethane ❑ ML ❑ MDL Tetrachloroethylene ❑ ML ❑ MDL Toluene ❑ ML ❑ MDL 1,1,1-trichloroethane ❑ ML ❑ MDL 1,1,2-trichloroethane ❑ ML ❑ MDL EPA Form 3510-2A (Revised 3-19) Page 14 TABLE EPA Identification Number C. EFFLUENT PARAMETERS NPDES Permit Number NC0075027 FOR SELECTED POTWS Maximum Daily Discharge Facility Name Cainsway HOA Average Outfall Number Daily Discharge Modified Analytical Method1 Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant Value Units Value Units Number of Samples Trichloroethylene ❑ ML ❑ MDL Vinyl chloride ❑ ML ❑ MDL Acid -Extractable Compounds p-chloro-m-cresol ❑ ML ❑ MDL 2-chlorophenol ❑ ML ❑ MDL 2,4-dichlorophenol ❑ ML ❑ MDL 2,4-dimethylphenol ❑ ML ❑ MDL 4,6-dinitro-o-cresol ❑ ML ❑ MDL 2,4-dinitrophenol ❑ ML ❑ MDL 2-nitrophenol ❑ ML ❑ MDL 4-nitrophenol ❑ ML ❑ MDL Pentachlorophenol ❑ ML ❑ MDL Phenol ❑ ML ❑ MDL 2,4,6-trichlorophenol ❑ ML ❑ MDL Base -Neutral Compounds Acenaphthene ❑ ML ❑ MDL Acenaphthylene ❑ ML ❑ MDL Anthracene ❑ ML ❑ MDL Benzidine ❑ ML ❑ MDL Benzo(a)anthracene ❑ ML ❑ MDL Benzo(a)pyrene ❑ ML ❑ MDL 3,4-benzofluoranthene ❑ ML ❑ MDL EPA Form 3510-2A (Revised 3-19) Page 15 TABLE EPA Identification Number C. EFFLUENT PARAMETERS NPDES Permit Number NC0075027 FOR SELECTED POTWS Maximum Daily Discharge Facility Name Cainsway HOA Average Outfall Number Daily Discharge Modified Analytical Method1 Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant Value Units Value Units Number of Samples Benzo(ghi)perylene ❑ ML ❑ MDL Benzo(k)fluoranthene ❑ ML ❑ MDL Bis (2-chloroethoxy) methane ❑ ML ❑ MDL Bis (2-chloroethyl) ether ❑ ML ❑ MDL Bis (2-chloroisopropyl) ether ❑ ML ❑ MDL Bis (2-ethylhexyl) phthalate ❑ ML ❑ MDL 4-bromophenyl phenyl ether ❑ ML ❑ MDL Butyl benzyl phthalate ❑ ML ❑ MDL 2-chloronaphthalene ❑ ML ❑ MDL 4-chlorophenyl phenyl ether ❑ ML ❑ MDL Chrysene ❑ ML ❑ MDL di-n-butyl phthalate ❑ ML ❑ MDL di-n-octyl phthalate ❑ ML ❑ MDL Dibenzo(a,h)anthracene ❑ ML ❑ MDL 1,2-dichlorobenzene ❑ ML ❑ MDL 1,3-dichlorobenzene ❑ ML ❑ MDL 1,4-dichlorobenzene ❑ ML ❑ MDL 3,3-dichlorobenzidine ❑ ML ❑ MDL Diethyl phthalate ❑ ML ❑ MDL Dimethyl phthalate ❑ ML ❑ MDL 2,4-dinitrotoluene ❑ ML ❑ MDL 2,6-dinitrotoluene ❑ ML ❑ MDL EPA Form 3510-2A (Revised 3-19) Page 16 TABLE EPA Identification Number C. EFFLUENT PARAMETERS NPDES Permit Number NC0075027 FOR SELECTED POTWS Maximum Daily Discharge Facility Name Cainsway HOA Average Outfall Number Daily Discharge Modified Analytical Method1 Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant Value Units Value Units Number of Samples 1,2-diphenylhydrazine ❑ ML ❑ MDL Fluoranthene ❑ ML ❑ MDL Fluorene ❑ ML ❑ MDL Hexachlorobenzene ❑ ML ❑ MDL Hexachlorobutadiene ❑ ML ❑ MDL Hexachlorocyclo-pentadiene ❑ ML ❑ MDL Hexachloroethane ❑ ML ❑ MDL Indeno(1,2,3-cd)pyrene ❑ ML ❑ MDL Isophorone ❑ ML ❑ MDL Naphthalene ❑ ML ❑ MDL Nitrobenzene ❑ ML ❑ MDL N-nitrosodi-n-propylamine ❑ ML ❑ MDL N-nitrosodimethylamine ❑ ML ❑ MDL N-nitrosodiphenylamine ❑ ML ❑ MDL Phenanthrene ❑ ML ❑ MDL Pyrene ❑ ML ❑ MDL 1,2,4-trichlorobenzene ❑ ML ❑ MDL 1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). EPA Form 3510-2A (Revised 3-19) Page 17 TABLE D. ADDITIONAL POLLUTANTS NPDES Permit Number NC0075027 AS REQUIRED BY NPDES PERMITTING Maximum Daily Discharge Facility Name Cainsway HOA AUTHORITY Average Outfall Number Daily Dischar e Modified Analytical Method Application Form 2A Modified March 2021 ML or MDL (include units) Pollutant (list) Value Units Value Units Number of Samples • No additional sampling is required by NPDES permitting authority. ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL E ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL ❑ ML ❑ MDL 1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). Page 18